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Hormones and body-fat distribution

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Calum Gore is an expert in medical biochemistry and health, and the founder of biochemical diagnostic testing services company Gore BioScience. He is based in Leicester, Leicestershire.

Hormones are the main messengers for communication between your organs and tissues. Keeping these hormones in the correct balance not only ensures a person is kept healthy, but can also establish whether – and crucially where – a person puts on additional body fat.

We come in a variety of shapes and sizes, but as a starting point men typically carry an android (apple) shape with women having the gynoid (pear) shape. From here we can go a step further and look to see whether there is a correlation between levels of key hormones and where fat is preferentially stored on your body. If there is, then skinfold measurements at certain sites could be a useful measure to track optimal hormone levels. Here’s a review of the latest evidence on whether certain hormones have an influence on the increase or decrease of body fat on particular areas of the body.

Insulin and fat distribution
Insulin is a hormone directly related to the amount of sugar consumed in the diet, therefore it is an important hormone to control body fat stores and associated metabolic disorders[1]. It is therefore important to monitor a person’s flux of sugar intake or glucose disposal ability. Popular anthropometric measures that have been shown to be important are body mass index (BMI), waist, hip and waist-to-hip ratio[2].

However, the skinfold thickness of the subscapula (shoulder blade) has been shown to be better than BMI and waist circumference in identifying hyperinsulinemia (excess insulin levels in the blood) in men and women[3]. Furthermore, the suprailliac (hip) skinfold has also been proven as an effective tool to track changes in sugar[4] along with vast research on the waist measurement being related to cardiovascular disease. Due to established research in insulin sensitivity linked to the subscapula, suprailiac and waist-to-hip measurement and the ease and practicality of taking these measurements is seems an important tool for monitoring insulin sensitivity and tracking dietary changes, especially sugar intake in the diet.

IronLife Insight Fat accumulation at your subscapular is strongly linked to elevated levels of insulin

Cortisol and fat distribution
Cortisol is a glucocorticoid and deemed the stress hormone. Its primary functions are to increase blood sugar (through converting amino acids to glucose), suppress inflammation, and aid with fat, protein and carbohydrate metabolism. Cortisol has also been associated anecdotally with the increase of fat in the abdominal region. There is evidence to suggest that glucocorticoids have multiple, depot-dependent effects on fat cell gene expression and metabolism that promote central fat deposits in the abdominal region[5]. Also the control of digestion could have an impact on abdominal fat storage. The most common gastrointestinal condition in the UK and USA is irritable bowel syndrome, with its prevalence being around 20-25%[6].

The intestines sit inline with the abdominal region and could cause fat storage due to a dysfunction of the lower digestive tract[7]. Therefore, measuring the stomach skinfold or a waist measurement could provide information on the stress and digestive health of an individual and measurements are fairly easy to take and monitor.

IronLife Insight Skinfold measurements of your abdominal region may offer some insight into your stress levels and/or the state of your digestive health

Testosterone and fat distribution
Research is limited on androgen balance and body fat distribution on the triceps, however pectoral (chest) body fat accumulation seems to be more commonly associated with fluctuations in androgen hormones, particularly in men. A condition called gynecomastia is caused by excessive estrogen actions, often the result of increased ratio of androgen-to-estrogen ratio in men[8].

A rare genetic and endocrine syndrome called aromatase excess syndrome shows an amplification of this and can lead to breast cancers in men and women. Furthermore, inflammation and increases in adipose fat around the breast in males may be associated with aromatising of androgens associated with lifestyle changes, although the same has not been found in women. Therefore, in men it seems viable to monitor the pectoral (chest) area in line with lifestyle changes, however in women, although a measurement further to the shoulder joint is proposed, this may not be a worthwhile measurement to monitor.

IronLife Insight There appears no link between elevated testosterone and skinfold measurements at the triceps, yet fat storage on the chest could indicate higher estrogen levels in men

Growth hormone and fat distribution
Growth hormone (GH) has become a popular performance-enhancing drug as an anabolic aid to alter body composition, and its deficiency is well recognised in a clinical setting to assess adverse health conditions associated with growth. It has also been proposed that skinfold measurements at knee and calf may indicate an imbalance in GH, albeit anecdotally.

A study on methods for screening growth hormone deficiency found that knee and calf skinfold measurement helped to determine deficiencies with growth hormone in children with severe growth problems[9]. However, this is an extreme case and is more related to genetic deficiencies, which is not representative of the general population. Therefore, whether it could be used to monitor small fluctuations in growth hormone it yet to be shown in the research and it must be considered that the knee could be an easily misinterpreted site due to inflammation issues.

IronLife Insight There appears to be no link between body-fat site distribution and growth hormone levels, either academically or anecdotally

Estrogen and fat distribution
Estrogen is the primary female sex hormone in women with functions to promote the development of female body shape characteristics, regulate the menstrual cycle and maintain a healthy libido[10]. Estrogen levels have been shown to be associated with lower body-fat distribution with research reporting hormone replacement therapy in women, resulted in an increase in leg fat[11].  Therefore, the research seems clear that increases in estrogen results in an increased fat storage around the legs. Biochemically this can be explained by the control of alpha and beta-adrenergic receptors on fat cells[12].

When alpha adrenal receptors on fat cells are up-regulated, lipolysis (fat burning) is decreased and estrogen in women (not men) results in a greater up-regulation of alpha adrenal receptors in the pelvic region[13]. One study on male to female transexuals found that estradiol treatment inhibited fat burning and as a result fat distribution shifted from the abdominal region to the pelvic region. This suggests that the location of the adrenal receptors is key in male and female differences in fat distribution. Males typically have adrenal receptors located around the abdominal region, hence why men store fat around the stomach, with women typically having adrenal receptors in the lower leg regions, hence women typically storing fat around the hips.

IronLife Insight Fat storage on the lower body, specifically around the hips, bottom and upper thighs, in women is closely linked to high levels of estrogen

In review of the effects of hormones on fat distribution, it is clear that research and anecdotal evidence have some groundings for assessment and subsequent dietary recommendations based around the above findings. Specifically it seems viable to monitor the subscapula (shoulder blade) and suprailliac (hip) in line with changes in dietary sugar control. Also, the abdominal region may offer some insight into the level of stress a person endures in their lifestyle and/or with their digestive health. Furthermore, male and female specific sites exist, whereby monitoring in one gender may be more insightful than in the other.

For example, the pectoral (chest) site in males may provide information in changes in androgens, but not in females. Also, the monitoring of lower body composition changes in females seems important to track above normal increases in estrogen levels, but in males may hold no real use. However, growth hormone in male or females seems to hold no standing in the literature and to save time and possible misinterpretation may be best avoided.

Therefore, with the following above recommendations, a simple yet effective monitoring tool could be established with male and female specific sites that is quick, simple, reliable. It could provide interesting information for trends in hormones related to an assessment of lifestyle changes linked to fat distribution.
It must always be understood, however, that any of these areas that fat accumulates are only an indication and further biochemical testing should be used for an accurate diagnosis of health conditions or hormonal changes.

1. Parillo, M. & Riccardi, G. 2004, “Diet composition and the risk of type 2 diabetes: epidemiological and clinical evidence”, British Journal of Nutrition, vol. 92, no. 01, pp. 7-19.
2. Wei, M., Gaskill, S.P., Haffner, S.M. & Stern, M.P. 1997, “Waist Circumference as the Best Predictor of Noninsulin Dependent Diabetes Mellitus (NIDDM) Compared to Body Mass Index, Waist/hip Ratio and Other Anthropometric Measurements in Mexican Americans—A 7-Year Prospective Study”, Obesity research, vol. 5, no. 1, pp. 16-23.
3. Misra, A., Madhavan, M., Vikram, N.K., Pandey, R.M., Dhingra, V. & Luthra, K. 2006, “Simple anthropometric measures identify fasting hyperinsulinemia and clustering of cardiovascular risk factors in Asian Indian adolescents”, Metabolism, vol. 55, no. 12, pp. 1569-1573.
4. Freedman, D.S., Ogden, C.L., Goodman, A.B. & Blanck, H.M. 2013, “Skinfolds and coronary heart disease risk factors are more strongly associated with BMI than with the body adiposity index”, Obesity, vol. 21, no. 1, pp. E64-E70.
5. Crist, B.L., Alekel, D.L., Ritland, L.M., Hanson, L.N., Genschel, U. & Reddy, M.B. 2009, “Association of oxidative stress, iron, and centralized fat mass in healthy postmenopausal women”,Journal of Women’s Health, vol. 18, no. 6, pp. 795-801.
6. Maxion-Bergemann, S., Thielecke, F., Abel, F. & Bergemann, R. 2006, “Costs of irritable bowel syndrome in the UK and US”, PharmacoEconomics, vol. 24, no. 1, pp. 21-37.
7. Bjarnason, I., Macpherson, A. & Hollander, D. 1995, “Intestinal permeability: an overview”, Gastroenterology, vol. 108, no. 5, pp. 1566-1581.
Braunstein, G.D. 1993, “Gynecomastia”, The New England journal of medicine, vol. 328, no. 7, pp. 490-495.
8. Braunstein, G.D. 1993, “Gynecomastia”, The New England Journal of Medicine, vol. 328, no. 7, pp. 490-495.
9. Bhatia, S.J., Moffitt, S.D., Goldsmith, M.A., Bain, R.P., Kutner, M.H. & Rudman, D. 1981, “A method of screening for growth hormone deficiency using anthropometrics”, The American Journal of Clinical Nutrition, vol. 34, no. 2, pp. 281-288.
10. Nilsson, S., Makela, S., Treuter, E., Tujague, M., Thomsen, J., Andersson, G., Enmark, E., Pettersson, K., Warner, M. & Gustafsson, J.A. 2001, “Mechanisms of estrogen action”, Physiological Reviews, vol. 81, no. 4, pp. 1535-1565.
11. Gambacciani, M., Ciaponi, M., Cappagli, B., Piaggesi, L. & Genazzani, A. 1997, “Effects of combined low dose of the isoflavone derivative ipriflavone and estrogen replacement on bone mineral density and metabolism in postmenopausal women”, Maturitas, vol. 28, no. 1, pp. 75-81.
12. Lafontan, M., Berlan, M., Sengenes, C., Moro, C., Crampes, F. & Galitzky, J. 2006, “cAMP-and cGMP-dependent control of lipolysis and lipid mobilization in humans: putative targets for fat cell management” in Insights into Receptor Function and New Drug Development Targets Springer, pp. 53-77.
13. Moore, E., Wisniewski, A. & Dobs, A. 2003, “Endocrine treatment of transsexual people: a review of treatment regimens, outcomes, and adverse effects”, Journal of Clinical Endocrinology & Metabolism, vol. 88, no. 8, pp. 3467-3473.


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